Dispensing doctors
October 2008
(This briefing applies to England only)
The Department of Health published a consultation paper, Pharmacy in England: Building on strengths- delivering the future in August 2008. The consultation paper follows the Pharmacy White Paper, which was published by the Department of Health in April 2008.
The consultation paper outlines four options for the future of dispensing doctor services. The BMA believes that the current arrangements for dispensing doctor services provide an efficient, convenient and highly valued system for providing patients with their treatment. In its consultation response, the BMA will argue that the principles of the current dispensing system (option one in the paper) ought to be maintained.
What are dispensing doctors?
Dispensing doctors are GPs who are allowed to both prescribe and dispense prescription only medicines to their patients from within their surgeries.
In which circumstances are doctors allowed to dispense medicines?
Doctors are allowed to dispense medicines in very specific circumstances. The system, which is already tightly regulated, requires the GP practice to be located in a designated rural area and there being a specified, minimum distance (currently 1.6km) between a patient’s home and the nearest community pharmacy.
How many dispensing doctors are there in England?
The BMA estimates that there are currently more than 6,000 dispensing doctors in England. There are 1,360 dispensing practices that provide NHS dispensing services to almost four million patients.
What are the benefits of dispensing GPs for patients?
As community pharmacies are not viable in many rural areas, dispensing doctors play a crucial role in ensuring that patients have access to, and receive, their medicines from their GP practice dispensary without having to make an additional, possibly long journey, to their nearest pharmacy. This is particularly vital for elderly, ill and frail patients and those from disadvantaged backgrounds who may not have access to a car or cannot afford to travel long distances to pick up their prescriptions. Some patients may also feel that such a service provides opportunities to strengthen the GP-patient relationship as well as maintaining continuity of care.
How much does the average dispensing doctor earn?
Dispensing doctors earn more than non-dispensing doctors because they are effectively running two separate, but interconnected services. Figures for 2007 show that the average net earnings of dispensing doctors contracted under the General Medical Services contract were £124,891. The average net earnings for dispensing GPs contracted under Personal Medical Services contracts were £134, 268. Visit website
What proportion of dispensing doctors' income is derived from dispensing medicines?
The proportion of dispensing doctors’ income derived from dispensing medicines varies from practice to practice and is largely dependent on the size of the dispensing list. In the more rural and remote practices, the proportion of income from dispensing can be as high as 50%.
How cost-effective are dispensing doctors compared to community pharmacists?
Information from the Prescription Pricing Divison of the NHS shows that dispensing doctors are marginally more cost effective than prescribing-only doctors: there is currently a difference of £1.53 per patient per annum in drug costs (including fees). Visit website
Is there any evidence that dispensing doctors prescribe more medicine than non-dispensing doctors?
Dispensing doctors prescribe more items than prescribing-only doctors but at a lesser cost per item. There are various reasons for this including:
- Better adherence to a 28 day repeat prescribing/ dispensing regime by dispensing doctors
- An inability for dispensing doctors to substitute cheaper, over-the-counter items for patients who pay for prescriptions
- An increased likelihood of prescriptions being dispensed as the dispensing takes place at the same time and same place as the prescribing.
The Department of Health has identified ‘persistent problems’ within the GP dispensing system, which it is seeking to redress through this consultation. These include concerns about cost: a financial analysis in the partial Impact Assessment (which has been challenged by the Dispensing Doctors’ Association) suggests that the total pharmaceutical costs associated with medicines dispensed by general practice are higher than the more common arrangements whereby a GP prescribes medicines and a pharmacy dispenses them. The DH does note however, that such additional costs may be justified where a community pharmacy would be unviable and the GP practice provides a dispensing service.
What effect could the Pharmacy White Paper have on dispensing doctors?
Some dispensing doctors have raised concerns that without a dispensing income, they may not be able to maintain a full range of medical services for their patients. In some instances, a practice’s dispensing income may cross subsidise its medical services: the loss of dispensing services could therefore have a detrimental impact on the provision of medical services in a number of practices and could lead to redundancies amongst practice staff. A survey of 453 dispensing doctors in July 2008 by the Dispensing Doctors Association found:
- 85% of respondents said that a loss of dispensing services would adversely affect general medical services
- 52% of respondents said a branch surgery would close
- 87% believed there would be a fragmentation of services
- 62% said there would be a reduction in practice nurses
- 83% predicted reduction in other services
Some dispensing doctors are concerned that investment in practices, such as expansion of medical services and improved access for patients, could be jeopardised if dispensing services are removed.
What is the BMA's position on the Pharmacy White Paper?
The consultation paper outlines four options for the future of dispensing doctor services:
- No change to the current arrangements which allow doctors to dispense medicines in specific circumstances.
- Allowing primary care trusts (PCTs) to determine in which rural localities GP dispensing is appropriate on the basis of a pharmaceutical needs assessment. This option would remove the current specific distance criteria (between a patient’s home and the nearest pharmacy) which helps determine whether a GP is able to dispense medicines.
- Making a specified distance between the dispensing surgery and the nearest community pharmacy (and not between the patient’s home and the pharmacy as in the current guidelines) the determining factor on whether or not a GP is able to dispense
- Preventing a GP from providing a dispensing service if there are two pharmacies within a specific distance.
The BMA supports option one: no change to the current arrangements.
For further information, please contact:
Email: parliamentaryunit@bma.org.uk